2023-09-28 14:46:10 +00:00
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abstract: 'Background: Access to safe surgical care represents a critical gap in
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healthcare delivery and development in many low-and middle-income
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countries, including Ethiopia. Quality improvement (QI) initiatives at
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hospital level may contribute to closing this gap. Many such quality
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improvement initiatives are carried out through international health
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partnerships. Better understanding of how to optimise quality
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improvement in low-income settings is needed, including through
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partnership-based approaches. Drawing on a process evaluation of an
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intervention to improve surgical services in an Ethiopian hospital, this
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paper offers lessons to help meet this need.
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Methods: We conducted a qualitative process evaluation of a quality
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improvement project which aimed to improve access to surgical services
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in an Ethiopian referral hospital through better management. Data was
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collected longitudinally and included: 66 in-depth interviews with
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surgical staff and project team members; observation (135 h) in the
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surgery department and of project meetings; project-related
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documentation. Thematic analysis, guided by theoretical constructs,
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focused on identifying obstacles to implementation.
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Results: The project largely failed to achieve its goals. Key barriers
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related to project design, partnership working and the implementation
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context, and included: confusion over project objectives and project and
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partner roles and responsibilities; logistical challenges concerning
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overseas visits; difficulties in communication; gaps between the time
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and authority team members had and that needed to implement and engage
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other staff; limited strategies for addressing adaptive-as opposed to
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technical-challenges; effects of hierarchy and resource scarcity on QI
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efforts. While many of the obstacles identified are common to diverse
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settings, our findings highlight ways in which some features of
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low-income country contexts amplify these common challenges.
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Conclusion: We identify lessons for optimising the design and planning
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of quality improvement interventions within such challenging healthcare
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contexts, with specific reference to international partnership-based
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approaches. These include: the need for a funded lead-in phase to
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clarify and agree goals, roles, mutual expectations and communication
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strategies; explicitly incorporating adaptive, as well as technical,
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solutions; transparent management of resources and opportunities;
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leadership which takes account of both formal and informal power
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structures; and articulating links between project goals and wider
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organisational interests.'
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affiliation: 'Aveling, EL (Corresponding Author), Univ Cambridge, Inst Publ Hlth,
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Cambridge Ctr Hlth Serv Res, Forvie Site,Robinson Way, Cambridge CB2 0SR, England.
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Aveling, EL (Corresponding Author), Harvard TH Chan Sch Publ Hlth, Dept Hlth Policy
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\& Management, Boston, MA 02115 USA.
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Aveling, Emma-Louise, Univ Cambridge, Inst Publ Hlth, Cambridge Ctr Hlth Serv Res,
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Forvie Site,Robinson Way, Cambridge CB2 0SR, England.
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Aveling, Emma-Louise, Harvard TH Chan Sch Publ Hlth, Dept Hlth Policy \& Management,
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Boston, MA 02115 USA.
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Zegeye, Desalegn Tegabu, Fed Minist Hlth, POB 1234, Addis Ababa, Ethiopia.
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Silverman, Michael, Univ Leicester, Dept Infect Inflammat \& Immun, Univ Rd, Leicester
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LE1 7RH, Leics, England.'
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article-number: '393'
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author: Aveling, Emma-Louise and Zegeye, Desalegn Tegabu and Silverman, Michael
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author-email: eaveling@hsph.harvard.edu
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author_list:
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- family: Aveling
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given: Emma-Louise
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- family: Zegeye
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given: Desalegn Tegabu
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- family: Silverman
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given: Michael
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da: '2023-09-28'
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doi: 10.1186/s12913-016-1639-4
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files: []
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issn: 1472-6963
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journal: BMC HEALTH SERVICES RESEARCH
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keywords: Quality improvement; Surgery; Patient safety; Partnership; Ethiopia
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keywords-plus: PATIENT SAFETY; COMMUNITY-DEVELOPMENT; CARE; INFRASTRUCTURE; UNIVERSITY
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language: English
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month: AUG 17
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number-of-cited-references: '36'
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orcid-numbers: Zegeye, Desalegn Tegabu/0000-0002-5231-9967
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papis_id: d878e9e2d53e8f84b031f111e7ddb672
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ref: Aveling2016obstaclesimplementat
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times-cited: '17'
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title: 'Obstacles to implementation of an intervention to improve surgical services
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in an Ethiopian hospital: a qualitative study of an international health partnership
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project'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000381463200002
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usage-count-last-180-days: '0'
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usage-count-since-2013: '9'
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volume: '16'
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web-of-science-categories: Health Care Sciences \& Services
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year: '2016'
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